Browsing by Author "Lohani, B"
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Publication Accuracy of ultrasonography in evaluation of level and cause of biliary obstruction: a prospective study(Kathmandu University, 2005) Ghimire, R; Lohani, B; Pradhan, SAim: To find out the accuracy of ultrasound in evaluation of level and cause of biliary obstruction. Materials and methods: Forty-five patients (26 to 86 years of age) with suspected biliary obstruction underwent Ultrasonography followed by Direct Cholangiograms (Percutaneous Transhepatic Cholangiography / Endoscopic Retrograde Cholangiography). The levels of biliary obstructions were grouped as hilar, suprapancreatic and intrapancreatic. Similarly the causes were grouped as malignant and benign. Diagnosis was confirmed either at surgery or histopathologically (USG-guided FNAC or ERC-biopsy). Results: Ultrasonography accurately identified the level of obstruction in 89 %( hilar), 91 %( suprapancreatic) and 87 %( intrapancreatic) cases. Malignancy was found in 33 patients and remaining 12 had benign diseases. USG accurately identified malignant and benign causes in 91% and 84% cases respectively. Findings were found to be statistically significant (p-value=<0.05 at 95%confidence interval). Conclusion: This study showed that USG has high accuracy in identifying the level and cause of biliary obstruction. Considering cost, availability and patient friendly nature, Ultrasound should be the first imaging modality of choice in evaluation of biliary obstruction. Key words: Ultrasound, biliary obstruction, direct cholangiogramPublication Correlation between Estimated Glomerular Filtration Rate (eGFR) and Sonographic Findings in Patients with Chronic Kidney Disease(Institute of Medicine, 2016) Neupane, NP; Lohani, BAbstract Introduction: Ultrasound can also be used as a non-invasive modality for the evaluation and grading of the chronic kidney diseases. This study aims to correlate the various sonographic parameters with the various grades of CKD based on the eGFR. Methods: The study was a cross sectional study conducted over a period of one year. Study population was adult patients (between 20 to 60 years) with chronic renal disease not undergoing renal replacement therapy. Patients with liver disease and fatty changes in liver in ultrasound and patient with ascites were excluded from the study. Estimated glomerular filtration rate (eGFR) was calculated by using Cockcroft- Gault (CG) equation and CKD classified according to Kidney Disease Improving Global Outcomes (KDIGO) 2004. Ultrasound was performed for all patients and data were entered in a predesigned proforma. Data analysis was done using SPSS 21.0. Results: A total of 138 patients met the inclusion criteria and were included in the study. The mean renal length in our study was 9.03cm (±0.83) on right and 9.00cm (±0.82) on the left side. The mean renal cortical thickness of right kidney was 1.037±0.20 cm and of left kidney was 1.039-±0.20 cm. Renal length and renal cortical thickness demonstrated a negative correlation with grade of CKD while renal echogenicity grading demonstrated a positive correlation with CKD grade. Conclusions: Renal Ultrasound may be used to grade and monitor progress of chronic kidney disease. Keywords: Chronic Kidney Disease, Estimated Glomerular Filtration Rate (eGFR), Renal Length, Ultrasound, Renal cortical thicknessPublication Correlation between Femoral Intercondylar Notch Width and Anterior Cruciate and Posterior Cruciate Ligament Widths on MRI of Knee Joint(Kathmandu University, 2023) Ghimire, P; Kayastha, P; Suwal, S; Katwal, S; Dhakal, P; Lamichhane, S; Lohani, BABSTRACT Background Anatomic variations have been implicated as one of the intrinsic causes of injuries to the cruciate ligaments which can induce a functional deficiency to the knee. Narrow cruciate ligament widths as well as narrow femoral intercondylar notch widths can increase the risk of these ligaments rupturing. Objective To correlate the width of the femoral intercondylar notch (ICN) with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) widths on MRI of the knee joint. Method A total of 46 patients who met the inclusion criteria were evaluated. Intercondylar notch was identified on coronal T1W images while anterior cruciate ligament and posterior cruciate ligament were identified on proton density coronal images. All the widths were measured in the same plane at a mid-coronal level where anterior cruciate ligament and posterior cruciate ligament cross each other. Result Our result showed a significant correlation between the widths of intercondylar notch and anterior cruciate ligament (r = 0.68, p < 0.001) and between intercondylar notch width (INW) and posterior cruciate ligament width (r = 0.65, p < 0.001). Overall, the mean intercondylar notch width measured was 17.5 ±2.5 mm (range 11.8 to 21.8 mm), the mean anterior cruciate ligament width was 5.9 ±1.3 mm (range 3.3 to 8.6 mm), and the mean posterior cruciate ligament width was 8.9 ±1.5 mm (range 5.9 to 11.8 mm). A statistically significant difference was observed between males and females for mean widths of intercondylar notch (p < 0.001) and posterior cruciate ligament (p=0.01). However, no statistically significant difference was seen for anterior cruciate ligament width (p=0.07) between the two genders. Conclusion Measurement of the femoral intercondylar notch width can be used as an indicator of anterior cruciate ligament and posterior cruciate ligament widths which can further assist to identify the individuals who are more susceptible to cruciate ligament injuries. KEY WORDS Anterior cruciate ligament, Cruciate ligament injury, Intercondylar notch width, MRI, posterior cruciate ligamentPublication Correlation between Sonoelastographic, Doppler and Histopathological Findings in Chronic Kidney Disease Patients in Tertiary Care Centre(Kathmandu University, 2022) Jha, SK; Lohani, B; Pant, AD; Chataut, D; Regmi, D; Bhatta, U; Gautam, N; Jha, GABSTRACT Background Ultrasound (USG) with Doppler examination of intrarenal vessels is the imaging modality of choice employed in patients with renal failure and is commonly performed early in the clinical course. The pulsatility index (PI) and the resistive index (RI) of downstream renal artery have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. Pathological process in any tissues alters their elastic properties which can be assessed non-invasively through newer technique like elastography. Objective To correlate the findings obtained by sonoelastographic, doppler and histopathological studies in chronic kidney disease patients. Method Study was done in 146 patients referred to Department of Radiodiagnosis and Imaging, TUTH for native renal biopsy. Renal sonographic morphology (length, echogenicity, cortical thickness), Sonoelastography (Young’s modulus) and Doppler parameters (peak systolic velocity, resistive index) were assessed. The grading of estimated GFR (eGFR) was calculated based on chronic kidney disease (CKD) criteria. Result Among 146 patients, 63 (43.2%) were females and 83 (56.8%) were males. Maximum patients were in age group of 41-50 years (25.3%) followed by age group 51-60 years (24%). Mean age of patient was 42.06±14.70 for males and 39.57±12.54 females. Maximum mean Young’s modulus was seen in eGFR stage G1 with 46.57±19.51 kPa followed by in stage G3a with 36.46±10.01 kPa and observed to be statistically non-significant (p=0.172). However, statistical significance difference was noted between the resistive index and elastographic measurement of Young’s modulus (r=0.462, p=0.0001). Minimum mean cortical thickness was seen in eGFR stage G5 with 4.42±1.48 mm followed by stage G4 with 5.57±1.24 mm (p= 0.0001). Cortical thickness is decreasing as eGFR stage was increasing in our study (p=0.0001). Resistive index is increasing with decrease in renal size (r=-0.202, p=0.015). Conclusion Ultrasonography along with doppler study and elastography have limited role in diagnosing the pathology of chronic kidney disease, however, it has significant role in the disease progression. KEY WORDS Chronic kidney disease, Doppler, Elastography, Resistive index, UltrasonographyPublication Evaluation of arterial phase images with 90vp in multiphase abdominal CT scan(Institute of Medicine, 2017) Chapagain, KM; Humagain, M; Lohani, B; Shrestha, SL; Thapa, NAbstract Introduction: CT scan of abdomen is usually performed in 120-140 kVp and such high ranges of kilovoltage in all phases will increases the radiation dose many fold. The purpose of the study was to qualitatively and quantitatively assess image quality with low kVp in arterial phase of examination of multiphasic abdominal CT study. Methods: A prospective cross-sectional study was done in 206 participants of age 18 to 88 years who were undergoing multiphase CT studies of the abdomen in Neusoft 16 detector MDCT. After performing non contrast scan, arterial phase study of limited region of abdomen (diaphragm to infrarenal margins) was obtained with 90 kVp. The portovenous phase scan with standard protocol was obtained (120kVp). All other scanning parameters were kept same for two phases. Images were rated on 5 point scale (1-worst, 2-Suboptimal, 3-adequate,4-very good,5-excellent) based on visualization of boundaries, anatomical details of the organs and visualization of noise and artifact by two radiologists. Patient weight, abdominal circumference (AC), height and BMI were recorded and correlated with the image quality score. Statistical analysis was done with Wilcoxon’s signed ranks test k test and descriptive analysis. Results: Overall the image quality of portovenous phase was significantly better (p<0.005) than low kVp arterial phase. Image quality score correlated best with abdominal circumference in standard dose technique (r=0.54) and patient weight in reduced dose technique (r=0.44). Arterial phase scanning had acceptable image quality score for patient weight of <60 kg, AC <80cm and BMI<25 kg/m2. The CTDIvol was 7.71 with reduced kVp protocol and 20.02 with standard resulting significant reduction in radiation dose of about 61% Conclusions: The image quality of arterial phase images with 90kVp tube potential is acceptable in thin and average built patients. Hence reduction in radiation dose is possible if arterial phase scanning is done with reduced kVp except in patients with large anthropometric parameters. Keywords: Arterial phase, CT, Image quality, Low kVp, Radiation dosePublication Predictive value of ultrasonography in the diagnosis of palpable breast lump(Kathmandu University, 2003) Pande, AR; Lohani, B; Sayami, P; Pradhan, SA lump is the first symptom in over 80 percent of all patients with cancer of the breast. Consequently, the finding of any lump in the breast is a highly significant sign and warrants a thorough investigation. The present study was undertaken to study the predictive value of ultrasonography in the diagnosis of palpable breast lumps. Fifty-two female patients with palpable breast lumps that were unilateral underwent ultrasonography of the breast. Thirty-six of these patients who had solitary, unilateral, solid lumps were followed up with FNAC/biopsy/mammography and the findings were compared. The mean age group was seen to be 41 years. The youngest patient was 17 years old and the oldest was 80 years. The validity of USG in the diagnosis of palpable breast lumps was calculated. A sensitivity value of 95%, specificity of 94.10%, positive and negative predictive values of 95.50% and 93.75% were noted and were comparable to other similar studies. The sensitivity, specificity, positive and negative predictive values were statistically significant (p=0.0000006) and were comparable to the values obtained by different studies conducted elsewhere. Among the multiple USG parameters, shape, margins, vascularity, surrounding tissue character, sound transmission through the lump were more significant in the diagnosis of benign vs. malignant lumps. Echogenicity and echotexture were of less significance. Key words: Breast lump, Ultrasound, FNACPublication Real Time Trans-Rectal Elastography of Prostate Correlation with Histopathology in a Suspected Case of Prostate Cancer(Kathmandu University, 2021) Basnet, B; Suwal, S; Chataut, D; Lohani, B; Paudel, SABSTRACT Background Early detection of prostate cancer, the second most common cancer in men worldwide, is the key for its successful treatment. Commonly used clinical criteria and imaging tools for detection of prostate cancer are less sensitive. Objective This study was aimed to find role of real time transrectal elastography of prostate for detection of prostate cancer. Method Study was conducted in 66 patients with clinical suspicion of prostate cancer, who were sent for ultrasound guided prostate biopsy. Transrectal ultrasound with real time elastography was performed in all the patients prior to the biopsy and looked for hard areas within the prostate. Then six-core tru-cut biopsy were taken in six zones of prostate, including the hard areas detected in the elastography. The histopathology report were correlated with the elastography findings. Result Median prostate specific antigen of the patients was 11.5 ng/ml with interquartile range of 8 to 23.5 ng/ml. Digital rectal examination showed hard nodular findings in 35 patients. Transrectal ultrasound showed 81 hypoechoic lesions in 31 patients. Elastography showed 127 hard areas in 31 patients. Histopathology showed 90 positive biopsy cores in 23 patients. Cancer detection rate of elastography was 82.6%. At 95% confidence interval, patients with elastography detected hard lesions had 19.4 times more likelihood to have prostate cancer. Sensitivity of elastography was high as compared to digital rectal examination and transrectal ultrasound alone. Conclusion Transrectal elastography had high sensitivity over clinical tools and transrectal ultrasonography for detection of prostate cancer. KEY WORDS Biopsy, Prostate cancer, Transrectal elastographyPublication Ultrasound elastography of liver: How Radiologist can help(Institute of Medicine, 2017) Maharjan, S; Panta, OB; Lohani, B; Pathak, YR; Ansari, MAAbstract Conventional Ultrasonography imaging does not provide information on mechanical properties of body tissues. Advances in ultrasound like contrast enhanced ultrasound, multiplaner 3D ultrasound and elastography have improved the performance of ultrasound in detection and characterization of pathologies and also has added a new dimension to conventional imaging technique. At this time, the use of elastography is not recommended for characterization of focal liver lesions, however in diffuse liver diseases Ultrasound elastography finds a role in identifying, classifying and grading fibrosis. Liver biopsy has been regarded as the gold standard to detect and classify liver fibrosis. However, due to high cost, inherent complications, invasive nature and its observer and sampling inadequacy, alternative methods to biopsy like Ultrasound elastography might have a role to play in detecting and grading liver fibrosis. This review focuses on the type of elastography and its role and applicability in various liver pathologies. Keywords: Elastography, Liver fibrosis, Stiffness, Ultrasonography